RESUMO
OBJECTIVES: Arrhythmogenic cardiomyopathy (ACM) is a complex cardiac disorder associated with ventricular arrhythmias. Understanding the relationship between mechanical uncoupling and cardiac structural changes in ACM patients is crucial for improved risk stratification and management. METHODS: In this study, we enrolled 25 ACM patients (median age 34 years, 72% men) based on the 2019 Modified Task Force and Padua criteria. Patients were categorized by the presence or absence of clinically relevant ventricular tachycardia (crVT), necessitating emergency interventions. Right ventricular-arterial coupling (VAC) was assessed using echocardiography. Low-rank regression splines were employed to model left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) in relation to VAC. RESULTS: Positive associations were observed between VAC and LVEF (ρ = 0.472, p = 0.023), RVEF (ρ = 0.522, p = 0.038), and right ventricular (RV) indexed stroke volume (ρ = 0.79, p < 0.001). Patients with crVT exhibited correlations with RV shortening, reduced RVEF (39.6 vs. 32.2%, p = 0.025), increased left ventricular (LV) mass (38.99 vs. 45.55, p = 0.045), and LV end-diastolic volume (LVEDV) (56.99 vs. 68.15 mL/m2, p = 0.045). Positive associations for VAC were noted with LVEDV (p = 0.039) and LV mass (p = 0.039), while negative correlations were observed with RVEF by CMR (p = 0.023) and RV shortening by echocardiography (p = 0.026). CONCLUSIONS: Our findings underscore the significance of right VAC in ACM, demonstrating correlations with RV and LVEF, RV stroke volume, and clinically relevant arrhythmias. Insights into RVEF, LV mass, and end-diastolic volume provide valuable contributions to the understanding of ACM pathophysiology and may inform risk assessment strategies.
OBJETIVOS: La miocardiopatía arritmogénica (MCA) es un trastorno cardíaco complejo asociado con arritmias ventriculares (AV). Comprender la relación entre el desacoplamiento mecánico y los cambios estructurales cardíacos en pacientes con MCA es crucial para una estratificación de riesgos y una gestión mejorada. MÉTODOS: En este estudio, reclutamos a 25 pacientes con MCA (edad media 34 años, 72% hombres) basándonos en los criterios del Task Force 2019 y los criterios de Padua. Los pacientes se clasificaron según la presencia o ausencia de taquicardia ventricular clínicamente relevante (crVT), que requería intervenciones de emergencia. Se evaluó el acoplamiento ventricular derecho-arterial (VAC) mediante ecocardiografía. Se utilizaron low-rank regression splines para modelar la fracción de eyección del ventrículo izquierdo (FEVI) y la fracción de eyección del ventrículo derecho (FEVD) en relación con el VAC. RESULTADOS: Se observaron asociaciones positivas entre el VAC y la FEVI (ρ = 0.472, p = 0.023), la FEVD (ρ = 0.522, p = 0.038) y el volumen de eyección indexado del ventrículo derecho (ρ = 0.79, p < 0.001). Los pacientes con crVT mostraron correlaciones con acortamiento del ventrículo derecho, disminución de la FEVD (39.6 vs. 32.2%, p = 0.025), aumento de la masa ventricular izquierda (38.99 vs. 45.55, p = 0.045) y volumen diastólico final del ventrículo izquierdo (VDVI) (56.99 vs. 68.15 mL/m2, p = 0.045). Se observaron asociaciones positivas para el VAC con el VDVI (p = 0.039) y la masa ventricular izquierda (p = 0.039), mientras que se observaron correlaciones negativas con la FEVD por RMC (p = 0.023) y el acortamiento del ventrículo derecho por ecocardiografía (p = 0.026). CONCLUSIONES: Nuestros hallazgos subrayan la importancia del VAC derecho en la MCA, demostrando correlaciones con la FEVD y FEVI, el volumen de eyección del ventrículo derecho y arritmias clínicamente relevantes. Las percepciones sobre la FEVD, la masa ventricular izquierda y el volumen diastólico final proporcionan contribuciones valiosas para comprender la fisiopatología de la MCA y pueden informar estrategias de evaluación de riesgos.
Assuntos
Displasia Arritmogênica Ventricular Direita , Volume Sistólico , Humanos , Masculino , Feminino , Adulto , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Displasia Arritmogênica Ventricular Direita/diagnóstico por imagem , Volume Sistólico/fisiologia , Pessoa de Meia-Idade , Ecocardiografia/métodos , Imageamento por Ressonância Magnética/métodos , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/etiologia , Estudo de Prova de Conceito , Adulto Jovem , Função Ventricular Direita/fisiologia , Função Ventricular Esquerda/fisiologiaRESUMO
BACKGROUND: Adverse remodeling of lung vessels elevates pulmonary pressure and provokes pulmonary arterial hypertension (PAH). PAH results in increased right ventricle (RV) afterload, causing ventricular hypertrophy and the onset of heart failure. There is no specific treatment for maladaptive RV remodeling secondary to PAH. OBJECTIVES: This study aims to explore two therapeutic approaches, grape juice (GJ) and thyroid hormones (TH), on PAH-induced oxidative stress and cardiac functional changes. METHODS: Parameters of echocardiography related to lung vessel resistance (AT/ET ratio), RV contractility (TAPSE), and RV diastolic function (E/A peaks ratio) were evaluated. Also, total ROS, lipid peroxidation, antioxidant enzymes, calcium handling proteins, pro-oxidant and antioxidant protein expression were measured. Values of p<0.05 were considered statistically significant. RESULTS: Both GJ and TH treatments demonstrated reductions in pulmonary resistance (~22%) and improvements in TAPSE (inotropism ~11%) and AT/ET ratio (~26%) (p<0.05). There were no changes amongst groups regarding the E/A peak ratio. Although ROS and TBARS were not statistically significant, GJ and TH treatments decreased xanthine oxidase (~49%) levels and normalized HSP70 and calcium handling protein expression (p<0.05). However, only TH treatment ameliorated diastolic function (~50%) and augmented NRF2 immunocontent (~48%) (p<0.05). CONCLUSIONS: To the best of our knowledge, this study stands as a pioneer in showing that TH administered together with GJ promoted functional and biochemical improvements in a PAH model. Moreover, our data suggest that GJ and TH treatments were cardioprotective, combined or not, and exhibited their beneficial effects by modulating oxidative stress and calcium-handling proteins.
FUNDAMENTO: A remodelação adversa dos vasos pulmonares eleva a pressão pulmonar e provoca hipertensão arterial pulmonar (HAP). A HAP resulta em aumento da pós-carga do ventrículo direito (VD), causando hipertrofia ventricular e consequente insuficiência cardíaca. Não existe um tratamento específico para o remodelamento desadaptativo do VD secundário à HAP. OBJETIVOS: Este estudo tem como objetivo explorar duas abordagens terapêuticas, o suco de uva (SU) e os hormônios tireoidianos (HT), no tratamento do estresse oxidativo induzido pela HAP e nas alterações funcionais cardíacas. MÉTODOS: Parâmetros ecocardiográficos relacionados à resistência dos vasos pulmonares (relação TA/TE), contratilidade do VD (ESPAT) e função diastólica do VD (relação dos picos E/A) foram avaliados. Além disso, foram medidos ROS totais, peroxidação lipídica, enzimas antioxidantes, proteínas de manipulação de cálcio, expressão de proteínas pró-oxidantes e antioxidantes. Valores de p<0,05 foram considerados estatisticamente significativos. RESULTADOS: Ambos os tratamentos, com SU e HT, demonstraram uma redução na resistência pulmonar (~22%), além de melhorias na ESPAT (inotropismo ~11%) e na relação TA/TE (~26%) (p<0,05). Não houve alterações entre os grupos na relação do pico de E/A. Embora ROS e TBARS não tenham sido estatisticamente significativos, os tratamentos com SU e HT diminuíram os níveis de xantina oxidase (~49%) e normalizaram a expressão de HSP70 e proteínas de manipulação de cálcio (p<0,05). No entanto, apenas o tratamento com HT melhorou a função diastólica (~50%) e aumentou o imunoconteúdo de NRF2 (~48%) (p<0,05). CONCLUSÕES: Até onde sabemos, este estudo é pioneiro ao mostrar que o HT administrado em conjunto com o SU promoveu melhorias funcionais e bioquímicas em um modelo de HAP. Além disso, nossos dados sugerem que os tratamentos com SU e HT se mostraram cardioprotetores, sejam combinados ou não, e exibiram seus benefícios ao modular o estresse oxidativo e as proteínas de manipulação do cálcio.
Assuntos
Modelos Animais de Doenças , Sucos de Frutas e Vegetais , Hipertensão Pulmonar , Estresse Oxidativo , Hormônios Tireóideos , Função Ventricular Direita , Vitis , Estresse Oxidativo/efeitos dos fármacos , Vitis/química , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/fisiopatologia , Animais , Masculino , Função Ventricular Direita/efeitos dos fármacos , Função Ventricular Direita/fisiologia , Ratos Wistar , Espécies Reativas de Oxigênio/metabolismo , Ecocardiografia , Antioxidantes/administração & dosagem , Remodelação Ventricular/efeitos dos fármacos , Remodelação Ventricular/fisiologia , Peroxidação de Lipídeos/efeitos dos fármacosRESUMO
BACKGROUND: Pulmonary valve regurgitation is a significant long-term complication in patients with tetralogy of Fallot (TOF). OBJECTIVE: This study aims to investigate the effects of pulmonary valve implantation (PVI) on the anatomy and function of the right ventricle (RV) and the long-term evolution of the implanted prosthesis in the pulmonary position. METHODS: A single-center retrospective cohort analysis was performed in 56 consecutive patients with TOF who underwent PVI. The study included patients of both sexes, aged ≥ 12 years, and involved assessing clinical and surgical data, pre- and post-operative cardiovascular magnetic resonance imaging, and echocardiogram data more than 1 year after PVI. RESULTS: After PVI, there was a significant decrease in RV end-systolic volume indexed by body surface area (BSA), from 89 mL/BSA to 69 mL/BSA (p < 0.001) and indexed RV end-diastolic volume, from 157 mL/BSA to 116 mL/BSA (p < 0.001). Moreover, there was an increase in corrected RV ejection fraction [ RVEFC = net pulmonary flow (pulmonary forward flow - regurgitant flow) / R V end-diastolic volume ] from 23% to 35% (p < 0.001) and left ventricular ejection fraction from 58% to 60% (p = 0.008). However, a progressive increase in the peak pulmonary valve gradient was observed over time, with 25% of patients experiencing a gradient exceeding 60 mmHg. Smaller prostheses (sizes 19 to 23) were associated with a 4.3-fold higher risk of a gradient > 60 mmHg compared to larger prostheses (sizes 25 to 27; p = 0.029; confidence interval: 1.18 to 17.8). CONCLUSION: As expected, PVI demonstrated improvements in RV volumes and function. Long-term follow-up and surveillance are crucial for assessing the durability of the prosthesis and detecting potential complications. Proper sizing of prostheses is essential for improved prosthesis longevity.
Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Pulmonar , Valva Pulmonar , Tetralogia de Fallot , Humanos , Tetralogia de Fallot/cirurgia , Tetralogia de Fallot/fisiopatologia , Tetralogia de Fallot/diagnóstico por imagem , Masculino , Feminino , Estudos Retrospectivos , Insuficiência da Valva Pulmonar/cirurgia , Insuficiência da Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/etiologia , Valva Pulmonar/cirurgia , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Resultado do Tratamento , Adulto , Adolescente , Adulto Jovem , Fatores de Tempo , Criança , Ecocardiografia , Função Ventricular Direita/fisiologia , Volume Sistólico/fisiologia , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Imageamento por Ressonância Magnética , Período Pós-OperatórioRESUMO
A análise da deformação miocárdica ventricular direita tem surgido como uma ferramenta diagnóstica importante na detecção de disfunção sistólica ventricular direita inicial não detectada pelas técnicas ecocardiográficas convencionais. Além disso, é capaz de trazer informações diagnósticas e prognósticas adicionais aos parâmetros tradicionais de avaliação da função sistólica ventricular direita em diversas patologias. O método ecocardiográfico de escolha para sua avaliação é o strain longitudinal derivado do speckletracking. Ele tem se mostrado mais sensível para pequenas mudanças na função sistólica quando comparado à excursão sistólica do plano do anel tricúspide, estudo da onda s´ ao Doppler tecidual do anel tricúspide e variação da área fracional do ventrículo direito. O avanço da inteligência artificial e a presença de softwares com análise automatizada entram neste cenário visando tornar a aplicabilidade do método mais simples, rápida e com menor variabilidade inter e intraobservador. O objetivo deste artigo de revisão é demonstrar o passo a passo da técnica, desde a otimização e aquisição de imagens até a interpretação dos resultados, com figuras ilustrativas de casos selecionados.(AU)
Right ventricular strain analysis has emerged as an important diagnostic tool in the detection of early right ventricular systolic dysfunction not detected by conventional echocardiography techniques. Furthermore, it is capable of providing additional diagnostic and prognostic information to the traditional parameters for evaluating right ventricular systolic function in various pathologies. The echocardiography method of choice for its assessment is longitudinal strain derived from speckletracking. This method has been shown to be more sensitive for small changes in systolic function when compared to tricuspid annular plane systolic excursion, tissue Doppler imaging of the tricuspid annular s' wave, and right ventricular fractional area change. Advances in artificial intelligence and software with automated analysis have been introduced to this scenario with the aim of making the method simpler and quicker to apply, with lower inter- and intra-observer variability. The objective of this review article is to demonstrate the technique step by step, from image optimization and acquisition to interpretation of results, with illustrative figures of selected cases.(AU)
Assuntos
Humanos , Função Ventricular Direita/fisiologia , Disfunção Ventricular Direita/diagnóstico por imagem , Ventrículos do Coração/anatomia & histologia , Ecocardiografia/métodos , Espectroscopia de Ressonância Magnética/métodos , Deformação Longitudinal Global/efeitos da radiação , Insuficiência Cardíaca/etiologiaRESUMO
El uso del catéter de arteria pulmonar es un método eficaz para la monitorización de los pacientes críticos. Aunque ampliamente utilizado en las Unidades de Cuidados Críticos Cardiológicos, no se ha demostrado en estudios previos el beneficio de su uso. Registros recientes y numerosos en pacientes graves cursando shock cardiogénico muestran un beneficio en términos de mortalidad asociada, sobre todo relacionado con una adecuada interpretación. Además, nuevos parámetros relacionados con insuficiencia ventricular como son el poder cardíaco y el índice de pulsatilidad de arteria pulmonar, así como el conocimiento de las presiones de llenado ventriculares, tanto izquierdas, como derechas, ayudan en la toma de decisiones, las opciones de tratamiento y estimación del pronóstico. Complementando lo anterior, la modernización en la tecnología del catéter de arteria pulmonar permite la medición del gasto cardíaco de forma continua a través de un sistema termodilución integrada. Este sistema también permite la monitorización más precisa del ventrículo derecho por medio de la valoración continua de su fracción de eyección y volumen de fin de diástole. La información obtenida por medio del catéter de arteria pulmonar en shock cardiogénico ha llevado a que su uso comience a ser cada vez más frecuente en unidades de cuidados críticos cardiológicos y que se empleen estos valores por equipos de shock cardiogénico para la toma de decisiones complejas. La evidencia descrita sobre el valor pronóstico relacionada al uso del catéter de arteria pulmonar se resume en esta revisión.
The pulmonary artery catheter is an effective tool for monitoring critically ill patients; however, the evidence showed limited value and a posible increased risk. Recently, numerous registries in critical ill patients in cardiogenic shock have shown a benefit in mortality, especially related to an adequate interpretation of findings. In addition, new parameters related to ventricular failure, such as cardiac power output and pulmonary artery pulsatility index have shown to be useful for a better treatment and estimation of prognosis. Besides, determination of filling pressures (right and/or left side) have an important role in terms of prognosis and management. Advances in pulmonary artery catheter technology allows us to continuously measure cardiac output through an integrated thermodilution system. This system also allows the continuous assessment of right ventricular ejection fraction and end-diastolic volume. The information obtained has led to an increased use of the pulmonary artery catheter monitoring in cardiac Intensive Care Units allowing improvements in treatment and complex decision-making.
Assuntos
Humanos , Choque Cardiogênico/terapia , Cateterismo de Swan-Ganz/métodos , Prognóstico , Débito Cardíaco/fisiologia , Função Ventricular Direita/fisiologia , Catéteres , Monitorização Hemodinâmica , Insuficiência Cardíaca/diagnósticoRESUMO
BACKGROUND: The pathophysiology of advanced liver cirrhosis may induce alterations in the circulatory system that may be challenging for the anesthesiologist to manage intraoperatively, and perioperative cardiovascular events are associated with worse outcomes in cirrhotic patients undergoing liver transplantation. It remains controversial whether right ventricular function is impaired during this procedure. Studies using transesophageal echocardiography for quantitative analysis of the right ventricle remain scarce in this setting, yielding conflicting results. The aim of this study was to perform a quantitative assessment of right ventricular function with two parameters derived from transesophageal echocardiography during liver transplantation. METHODS: Nineteen adult patients of both genders undergoing liver transplantation were evaluated in this observational study. The exclusion criteria were age under 18 or above 65 years old, fulminant hepatic failure, hepatopulmonary syndrome, portopulmonary hypertension, cardiopulmonary disease, and contraindications to the transesophageal echocardiogram. Right ventricular function was assessed at five stages during liver transplantation: baseline, hepatectomy, anhepatic, postreperfusion, and closure by measuring tricuspid annular plane systolic excursion and right ventricular fractional area change obtained with transesophageal echocardiography. RESULTS: Right ventricular function was found to be normal throughout the procedure. The tricuspid annular plane systolic excursion showed a trend toward a decrease in the anhepatic phase compared to baseline (2.0 ± 0.9 cm vs. 2.4 ± 0.7 cm; P = 0.24) but with full recovery after reperfusion. Right ventricular fractional area change remained nearly constant during all stages studied (minimum: 50% ± 10 at baseline and anhepatic phase; maximum: 56% ± 12 at postreperfusion; P = 0.24). CONCLUSIONS: Right ventricular function was preserved during liver transplantation at the time points evaluated by two quantitative parameters derived from transesophageal echocardiogram.
Assuntos
Transplante de Fígado , Disfunção Ventricular Direita , Adulto , Idoso , Ecocardiografia Transesofagiana/métodos , Feminino , Ventrículos do Coração , Humanos , Masculino , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/etiologia , Função Ventricular Direita/fisiologiaRESUMO
Abstract Objective: Right ventricle (RV) function plays an important role during fetal and neonatal transitional circulation. Despite the published echocardiography guidelines in children including neonates, there is scare evidence on RV assessment using echocardiography in Mexican neonates. This study was aimed at assessing RV function and anatomical measures in healthy term newborns and defines normal values in this cohort of patients. Methods: A prospective study involving healthy term newborns in a single center were enrolled in the study to assess RV, all patients were recruited within 24-72 h after birth. The right ventricular assessment was performed as per American Society of Echocardiography's guidelines. Results: Seventy healthy term newborns with a median gestational age of 38 (38.5 ± 2.7) weeks had RV function assessment and anatomical structures measures with a predefined ten echocardiographic parameters protocol. The mean values for: tricuspid valve diameter was 13 mm ± 1.8, basal diameter of the RV 16.7 mm ± 2, RV length 27.8 mm ± 2.2, mid cavity diameter 14.3 mm ± 1.7, RV-anteroinferior basal diameter 21.5 mm ± 2.5, tricuspid regurgitation gradient 13.3 mmHg ± 5.9, tricuspid annular plane systolic excursion 8.7 mm, right ventricular fractional area change (RVFAC) 4 chamber (%) 40.6 ± 7.5, tricuspid E/A 0.7 ± 0.5, myocardial velocities (cm/s) E´ 8 ± 2.7, A´ 9.6 ± 2.4, S´ 6.9 ± 1.2, myocardial performance index 0.5 ± 0.1, RVFAC 3 chamber (%) 37.8 ± 15.8, and pulmonary acceleration time mean value 58.8 ± 14.9. Flattening of interventricular septum was seen in 13% infants. Conclusions: This study describes echocardiographic parameters for anatomical structures and assessment of RV function in healthy term newborns during transitional circulation. We reported novel anatomical measures of the RV; this information can provide normal reference range values and be referenced while assessing RV function in normal and sick newborns during transitional circulation.
Resumen Objetivo: Realizar una valoración ecocardiográfica de parámetros anatómicos y funcionales del ventrículo derecho (VD) en recién nacidos de término (RNT) sanos durante el periodo transicional. Método: Estudio prospectivo en RNT sanos de la Unidad de Cuidados Intensivos Neonatales del Hospital Español. Todos los pacientes fueron estudiados en las primeras 24-72 horas de vida, con base en las guías de la American Society of Echocardiography. Resultados: Se estudiaron 70 RNT sanos con una media de edad gestacional de 38 semanas de gestación (38.5 ± 2.7); en estos pacientes se obtuvieron 10 parámetros ecocardiográficos. El valor medio obtenido para la válvula tricúspide fue de 13 ± 1.8 mm, diámetro basal del VD 16.7 ± 2 mm, longitud 27.8 ± 2.2 mm, cavidad media del VD 14.3 ± 1.7 mm, diámetro basal anteroinferior 21.5 ± 2.5 mm, gradiente de insuficiencia tricuspídea 13.3 ± 5.9 mmHg, tricuspid annular plane systolic excursion (TAPSE) 8.7 mm, Fracción de acortamiento del VD (FAVD) 4 cámaras (%) 40.6 ± 7.5, E/A tricuspídeo 0.7 ± 0.5, velocidades miocárdicas (cm/s) E´ 8 ± 2.7, A´ 9.6 ± 2.4, S´ 6.9 ± 1.2, índice de rendimiento miocárdico 0.5 ± 0.1, FAVD 3 cámaras (%) 37.8 ± 15.8, tiempo de aceleración pulmonar 58.8 ± 14.9. Conclusiones: Este estudio describe parámetros anatómicos y funcionales del VD en RNT sanos durante el periodo de transición. Se reportan valores de normalidad que pueden servir como referencia.
Assuntos
Humanos , Masculino , Recém-Nascido , Criança , Ecocardiografia/métodos , Função Ventricular Direita/fisiologia , Ventrículos do Coração/anatomia & histologia , Ventrículos do Coração/diagnóstico por imagem , Valores de Referência , Estudos Prospectivos , MéxicoRESUMO
OBJECTIVE: Right ventricle (RV) function plays an important role during fetal and neonatal transitional circulation. Despite the published echocardiography guidelines in children including neonates, there is scare evidence on RV assessment using echocardiography in Mexican neonates. This study was aimed at assessing RV function and anatomical measures in healthy term newborns and defines normal values in this cohort of patients. METHODS: A prospective study involving healthy term newborns in a single center were enrolled in the study to assess RV, all patients were recruited within 24-72 h after birth. The right ventricular assessment was performed as per American Society of Echocardiography's guidelines. RESULTS: Seventy healthy term newborns with a median gestational age of 38 (38.5 ± 2.7) weeks had RV function assessment and anatomical structures measures with a predefined ten echocardiographic parameters protocol. The mean values for: tricuspid valve diameter was 13 mm ± 1.8, basal diameter of the RV 16.7 mm ± 2, RV length 27.8 mm ± 2.2, mid cavity diameter 14.3 mm ± 1.7, RV-anteroinferior basal diameter 21.5 mm ± 2.5, tricuspid regurgitation gradient 13.3 mmHg ± 5.9, tricuspid annular plane systolic excursion 8.7 mm, right ventricular fractional area change (RVFAC) 4 chamber (%) 40.6 ± 7.5, tricuspid E/A 0.7 ± 0.5, myocardial velocities (cm/s) E´ 8 ± 2.7, A´ 9.6 ± 2.4, S´ 6.9 ± 1.2, myocardial performance index 0.5 ± 0.1, RVFAC 3 chamber (%) 37.8 ± 15.8, and pulmonary acceleration time mean value 58.8 ± 14.9. Flattening of interventricular septum was seen in 13% infants. CONCLUSIONS: This study describes echocardiographic parameters for anatomical structures and assessment of RV function in healthy term newborns during transitional circulation. We reported novel anatomical measures of the RV; this information can provide normal reference range values and be referenced while assessing RV function in normal and sick newborns during transitional circulation.
OBJETIVO: Realizar una valoración ecocardiográfica de parámetros anatómicos y funcionales del ventrículo derecho (VD) en recién nacidos de término (RNT) sanos durante el periodo transicional. MÉTODO: Estudio prospectivo en RNT sanos de la Unidad de Cuidados Intensivos Neonatales del Hospital Español. Todos los pacientes fueron estudiados en las primeras 24-72 horas de vida, con base en las guías de la American Society of Echocardiography. RESULTADOS: Se estudiaron 70 RNT sanos con una media de edad gestacional de 38 semanas de gestación (38.5 ± 2.7); en estos pacientes se obtuvieron 10 parámetros ecocardiográficos. El valor medio obtenido para la válvula tricúspide fue de 13 ± 1.8 mm, diámetro basal del VD 16.7 ± 2 mm, longitud 27.8 ± 2.2 mm, cavidad media del VD 14.3 ± 1.7 mm, diámetro basal anteroinferior 21.5 ± 2.5 mm, gradiente de insuficiencia tricuspídea 13.3 ± 5.9 mmHg, tricuspid annular plane systolic excursion (TAPSE) 8.7 mm, Fracción de acortamiento del VD (FAVD) 4 cámaras (%) 40.6 ± 7.5, E/A tricuspídeo 0.7 ± 0.5, velocidades miocárdicas (cm/s) E´ 8 ± 2.7, A´ 9.6 ± 2.4, S´ 6.9 ± 1.2, índice de rendimiento miocárdico 0.5 ± 0.1, FAVD 3 cámaras (%) 37.8 ± 15.8, tiempo de aceleración pulmonar 58.8 ± 14.9. CONCLUSIONES: Este estudio describe parámetros anatómicos y funcionales del VD en RNT sanos durante el periodo de transición. Se reportan valores de normalidad que pueden servir como referencia.
Assuntos
Ecocardiografia/métodos , Ventrículos do Coração , Função Ventricular Direita/fisiologia , Criança , Ventrículos do Coração/anatomia & histologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Recém-Nascido , Masculino , México , Estudos Prospectivos , Valores de ReferênciaRESUMO
OBJECTIVE: To identify the measures of biventricular function and surrogates of pulmonary vascular resistance that can be expected in relatively stable extremely premature neonates, and evaluate maturational changes in myocardial performance in this patient population. STUDY DESIGN: This was a prospective observational study. Clinically stable extremely preterm newborns were divided into 3 cohorts based on gestational age: cohort 1 (240/7-256/7 weeks), cohort 2 (260/7-276/7 weeks), and cohort 3 (280/7-296/7 weeks). Serial echocardiograms were obtained on day of life 3-5, 7-10, and just prior to discharge. RESULTS: In total, 46 subjects met the criteria aimed at capturing only the most clinically healthy and stable newborns less than 296/7 weeks of gestational age. Myocardial performance was reliably assessed by echocardiography with high inter-reader correlation. Normative values were identified for right ventricular function, left ventricular function, and surrogates of pulmonary vascular resistance. CONCLUSIONS: Biventricular systolic performance is significantly different in the clinically stable extremely premature neonate when compared with healthy full-term newborns. All participants had evidence of poor biventricular compliance at birth which improved with maturation. Extreme prematurity does not appear to adversely affect myocardial functional maturation at the time of term corrected age and/or discharge.
Assuntos
Coração/crescimento & desenvolvimento , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Recém-Nascido/crescimento & desenvolvimento , Função Ventricular Esquerda/fisiologia , Função Ventricular Direita/fisiologia , Fatores Etários , Ecocardiografia , Feminino , Idade Gestacional , Coração/diagnóstico por imagem , Humanos , Masculino , Estudos Prospectivos , Valores de Referência , Sístole , Resistência Vascular/fisiologiaRESUMO
Patients with Chagas cardiomyopathy (ChC) usually progress with fatigue and dyspnea. Exercise tests are valuable for the functional evaluation of these patients. However, information about the applicability of the exercise tests is scattered, and no studies have systematically reviewed the results. Thus, the present review explored the general aspects and prognostic value of exercise tests in patients with ChC. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed to identify relevant studies. There were no data restrictions, and articles that met the objective of the study were selected. Articles written in English, Portuguese, and Spanish were considered, and 25 articles were finally included. The peak oxygen uptake (VO2peak) was correlated with demographic and echocardiographic variables. Echocardiographic features of the left ventricular diastolic function and right ventricular systolic function appeared to be determinants of functional capacity, in addition to age and sex. VO2peak was associated with higher mortality, especially in patients with dilated ChC. The minute ventilation/carbon dioxide production slope (VE/VCO2 slope) was a strong predictor of survival; however, more studies are needed to verify this observation. Field tests showed moderate to strong correlation with VO2peak and thus may be inexpensive tools for the functional evaluation of patients with ChC. However, few studies have verified their prognostic significance. While exercise tests are useful tools for functional assessment, information is scarce regarding further considerations, and many of the criteria are based on guidelines for other heart diseases.